Provider Demographics
NPI:1255932794
Name:PROHEALTH HOME CARE, INC.
Entity type:Organization
Organization Name:PROHEALTH HOME CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HOFF
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:701-721-1126
Mailing Address - Street 1:5101 14TH ST SE
Mailing Address - Street 2:
Mailing Address - City:MINOT
Mailing Address - State:ND
Mailing Address - Zip Code:58701-3212
Mailing Address - Country:US
Mailing Address - Phone:701-721-1126
Mailing Address - Fax:
Practice Address - Street 1:702 33RD AVE SW
Practice Address - Street 2:
Practice Address - City:MINOT
Practice Address - State:ND
Practice Address - Zip Code:58701-7368
Practice Address - Country:US
Practice Address - Phone:701-721-1126
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1456793Medicaid